Introduction : Violence in hospital is a major Public Health issue. In Cote d’Ivoire, acts of violence against health professionals exist and may sometimes take a dramatic turn. Objective: To research the causes of this violence for the purpose to prevent them. Materials and Methods : This is a cross-sectional, descriptive study conducted in the Obstetrics & Gynecology and Pediatrics departments at the University Teaching Hospital of Bouaké from 26 January 2016 to 24 February 2016. It included 129 health workers who gave their consent. The data collection was done through individual interviews followed by a focus group according to the socio-professional category. Results: Out of 129 health professionals included, 100 were a victim of violence i.e. a frequency of 77.5%. Most of the violence occurred during “ on-call hours ” (55.8%) in the emergency units (34.8%). The violence was verbal (52.5%), physical (28.6%), moral and psychological (11.6%), theft (7.3%). The aggression was mainly related to patient’s care (32.1%), visiting hours (26%) and the low level of understanding of the person (16.5%). The victim’s immediate feelings were dominated by frustration (26.7%), discouragement (21.3%) and insecurity (18.3%). The victims received a medical assistance in 9% of cases. To prevent this violence, the staff mainly offered to raise awareness about violence (27.6%) and the respect for hospital staff (25%). Conclusion : Violence against health professionals is common and has negative impacts on staff and hospital activity. It s prevention requires a holistic approach centered on awareness. Keywords: Violence, Hospital, Pediatrics, Staff, Cote d’Ivoire.
The World Health Organization (WHO) defines violence at workplace as the intentional use of real or apprehended power against a person or group of people, in work-related circumstances leading to a high degree of probability of trauma, psychological harm, mischief or deprivation and death [
This is a prospective cross-sectional study with descriptive intent. It took place at the University Teaching Hospital (CHU) of Bouaké in the Pediatric and Obstetrics & Gynecology departments from 26 January 2016 to 24 February 2016. The Pediatrics and Obstetrics & Gynecology departments, are the only tertiary-level referral services in the health pyramid in the Gbêkê region. They are located at about 347 km from Abidjan, the economic capital in the south of the country. The annual admissions in the department of Pediatrics, all units combined (Neonatology and General Pediatrics) is nearly 19,000 patients and has 99 workers all socio-professional category. Similarly, The Obstetrics & Gynecology Department has 138 active staff. These two services represent in terms of activities, nearly two-thirds of the total volume of activities of the University Teaching Hospital of Bouaké and therefore constitute the main gateway to this reference health facility in the Gbêkê administrative region. The study population is represented by the staff of both departments. Included in the study were all personnel working in these services, recognized by the Human Resources Department of the University Teaching Hospital (CHU) of Bouaké, present at the time of the survey and gave a written informed consent. All personnel absent at the time of the investigation due to illness, leave or annual leave were not included in the study.
We conducted a guided interview with all staff meeting the inclusion criteria. The information collected was recorded on two structured survey sheets, anonymized and validated by one independent expert. In this study, the level of education of staff was defined as follows: primary (≤6 years of education), secondary (7 and 13 years of education), higher (≥14 years of education). The data was captured and analyzed on the statistical software SPSS version 20. The analysis was descriptive and consisted of calculating the numbers and determining averages and proportions. Quantitative variables were analyzed as mean with standard deviation. The qualitative variables were expressed as a proportion. The comparison of the quantitative variables was done with the chi-2 test. The threshold of significance was set for a value of p ≤ 0.05.
They were materialized by the informed consent of the participants, the anonymity of the data collection forms and by the research authorization from the Scientific Medical Directorate of the University Teaching Hospital with copying to the heads of the services concerned.
From the total of 237 health professionals in both services, 129 participants were enrolled representing a participation rate of 54.4%. Seventy-one (71) were from the Pediatrics department and fifty eight (58) from the Obstetrics & Gynecology department. There were 72 women and 57 men, a sex ratio of 0.8. The average age was 36 ± 6 years [extreme 26 and 55 years]. The participants’ had a higher level of education in 65.8%, secondary education in 33.3% and primary education in 0.9%. Professional seniority ranged from 3 months to 26 years with an average of 6 years. 38.3% of the interviewed personnel were working in emergency services and 19.8% in the wards. The other socio-demographic characteristics of the participants are presented in
Parameter | n | Percentage |
---|---|---|
Sex | ||
Male | 57 | 44.2 |
Female | 72 | 55.8 |
Age | ||
<36 years | 55 | 42.6 |
36 - 45 years | 59 | 45.7 |
>45 years | 10 | 11.7 |
Level of education | ||
Tertiary | 85 | 65.9 |
High School | 43 | 33.3 |
Primary | 1 | 0.8 |
Year of seniority in the position | ||
0 - 5 years | 65 | 50.4 |
6 - 10 years | 43 | 33.3 |
>10 years | 15 | 16.3 |
Year of seniority in service | ||
0 - 5 years | 83 | 64,3 |
6 - 10 years | 37 | 28,7 |
>10 years | 9 | 7 |
Service or Work unit | ||
Emergency room | 97 | 38.3 |
Hospitalization | 50 | 19.8 |
Treatment room | 28 | 11.1 |
Neonatology | 25 | 10 |
Consultation | 23 | 9 |
Reception | 23 | 9 |
Prevention | 7 | 2.8 |
Marital status | ||
Married | 51 | 39.5 |
Concubine | 27 | 21 |
Single | 51 | 39.5 |
Religion | ||
Christian | 93 | 72.1 |
Muslim | 27 | 21 |
Animist | 9 | 6.9 |
One hundred of the 129 staffs interviewed said they had been victims of violence at least once i.e. a frequency of 77.5%. Forty-five were from the Pediatrics Department and 55 from Obstetrics & Gynecology. There were 49 men and 51 women i.e. a sex ratio of 0.96.
The violence was perpetrated in the emergency room in 36.8%, in reception room in 17.2% and the ward in 12.3% of cases. Aggression took place between 8 am and 6 pm in 54% of cases and between 6 pm and 8 am in 46% of cases. The characteristics of the violence are presented in
The four main feelings of the victims of violence were frustration (26.7%), discouragement (21.3%), feelings of insecurity (18.3%) and humiliation (17%). The victims reported that violence affected their working activity in 44% of cases. It was the lack of self-investment (59.6%), the desire to change jobs (24.2%) and the lack of compassion (14.1%).
Nine of the 100 victims (9%) reported having received medical assistance after the attack. All the victims claimed that they had no legal recourse after the attack. To prevent violence on the staff, the victims proposed to raise awareness against violence (27.6%), to campaign for respect for the staff working in the hospital (25%) and the implementation of a policy of zero tolerance to violence (12.5%).
This cross-sectional and descriptive study aims to investigate the causes of violence against staff working in the pediatric and Obstetrics & Gynecology departments of the University Teaching Hospital (CHU) of Bouaké with a view to prevent it and improve the professional practice. It relies on staff declarations based on honor from memory without confirmation of their accuracy by incident reporting forms. As a result, memory bias is possible. In addition, the study is mono-centric and does not take into account cases of violence against staff perpetrated in other health centers. As a result, the results of the study cannot be generalized to the whole country. Nevertheless, despite the methodological
Parameters | n/N | Percentage |
---|---|---|
Frequency of violence | ||
1 | 32/100 | 32 |
[ | 38/100 | 38 |
[ | 5/100 | 5 |
>5 | 25 | 25 |
Nature of the violence | ||
Verbal | 217/413 | 52.5 |
Physical | 118/413 | 28.6 |
Moral and psychological | 48/413 | 11.6 |
Theft | 30/413 | 7.3 |
Reasons of the violence | ||
Problems related to health care support while in Hospital | 72/224 | 32.1 |
Visiting hours | 58/224 | 26 |
Level of understanding | 37/224 | 16.5 |
Very aggressive person | 26/224 | 11.6 |
Financial problems | 13/224 | 5.8 |
Others* | 18/224 | 8 |
Others*: Refusal of the prescription with respect to the government free admission policy (3), announcement of death (2), sorting of patients (2), discharges against medical opinion (2), welcoming of patients (2), pathological status (2), threat (2), fatigue related to hospital procedures (1), violation of hospital instructions (1), racketeering (1).
Parameter | n (%) | p-value |
---|---|---|
Socio-professional category | ||
- Nurses & Midwives | 33 (33) | 0.89 |
- Assistant Nurses | 31 (31) | |
- Doctors | 27 (27) | |
- Security guards | 6 (6) | |
- Hospital service agents | 3 (3) | |
Sex | ||
- Male | 49 (49) | 0.045* |
- Female | 51 (51) | |
Year of seniority in the position | ||
- 0-5 years | 50 (50) | 0.95 |
- >5 years | 50 (50) | |
Year of seniority in service | ||
- 0-5 years | 64 (64) | 0.95 |
- >5 years | 36 (36) |
*p-value significant.
limitation, this work provided for the first time in Côte d’Ivoire some information on violence against health workers in Pediatric and Obstetrics & Gynecology services and could be further by other subsequent studies. The study raises the following points of discussion.
The overall participation rate for staff in both departments is 54.4%. A lower rate, 45%, was reported in the United States in 2009 by Karen et al. [
The study reported a prevalence of 77.5% of violence on health professionals. This rate is in the range with 66.8% to 90.7% reported between 2007 and 2015 in the literature [
In the study, the abused staffs are mostly frustrated, feel humiliated and insecure, with discouragement, abandon or lack of concentration as drawback. The feelings experienced by the staff have already been reported by other authors in the literature [
Violence against health professionals exists at the University Teaching Hospital of Bouaké. It affects all socio-professional categories and the quality of care provided. The causes are numerous and inherent to both the patient and the hospital staff. Its prevention requires a holistic approach centered on awareness and the improvement of communication tools. It is therefore important that political, administrative, and health professionals work together to put in place a national risk management policy and program to deal with the issues.
We thank all the administrative team of the University Teaching Hospital (CHU) of Bouaké for having authorized us to carry out this work. We also thank all the staff of the Pediatric and Obstetrics & Gynecology departments for their active participation.
All authors have contributed intellectually to the drafting and revision of this manuscript.
Asse, K.V., Azagoh-Kouadio, R., Yao, K.C., Aka-Tanoh, K.A., Avi, C., Yeboua, K.R., Yenan, J.P., Ehouman, M.A., Doumbia, Y. and Plo, K.J. (2018) Violence on Health Professionals: Experience of the Obstetrics & Gynecology and Pediatrics Departments at the University Teaching Hospital of Bouaké, Côte d’Ivoire. Open Journal of Pediatrics, 8, 8-18. https://doi.org/10.4236/ojped.2018.81002